Cannabis use linked to earlier onset of psychosis

 Cannabis users develop psychosis an average of two-and-a-half years earlier than nonusers, a new meta-analysis by UNSW Sydney researchers shows. This earlier onset of psychosis becomes more pronounced with age, stretching to a difference of more than six years between cannabis users and nonusers who develop psychosis in their 30s, according to the global analysis, published in Biological Psychiatry.

Psychosis is a symptom of schizophrenia and other mental illnesses and can involve delusions, hallucinations, disordered thinking and behavior. It typically emerges in late adolescence or early adulthood but can occur across a wide age span. Up to 3% of adults experience a diagnosed disorder involving psychosis in their lifetimes, according to Psychosis Australia.

Researchers from UNSW Medicine examined 149 studies involving more than 71,000 people, largely conducted in Europe, North America and Australia since 2011. The majority focused on people with schizophrenia.

In studies in which psychosis developed at an average age of 20–24 years, researchers found that cannabis users experienced their first episode an average of 1.6 years earlier than nonusers. The difference increased to 4.43 years in studies in which psychosis developed in the mid-to-late 20s (25–29) and to 6.3 years among those 30 and older.

Chief investigator and psychiatrist Matthew Large, a conjoint professor with UNSW's School of Clinical Medicine, said the findings showed cannabis use was linked to the earlier onset of psychosis, and its effect appeared to build over time.

"We've tended to focus on the dangers of using cannabis in adolescence, when the brain is still developing, but the risk doesn't disappear once you're in your 20s," Large said. "What we're seeing suggestsa cumulative effect, where harm builds up over time, a bit like alcohol or nicotine."

The researchers found no significant difference in the age of psychosis onset between teenagers who used cannabis and nonusers but noted that its rarity before the midteens left a limited window for earlier onset.

"There may be a biological floor, in that there is only so much earlier that onset can be shifted. In younger groups, strong development, genetic or other psychosis risk factors may dominate, making any cannabis-related age shift harder to detect," Large said.

He noted the study did not prove that cannabis caused psychosis or brought it forward, as doing so would require experimental research that would be unethical.

"But the consistency of the evidence, particularly the strong effect in older adults who likely have been using cannabis for longer, does support the theory that cannabis plays a causal role in the timing of psychosis onset, and possibly the onset of some cases among people who would not have otherwise developed psychosis."

 

A closer look at the research

The study follows a smaller 2011 meta-analysis led by Large that found psychosis began 2.7 years earlier for cannabis users, and a 2015 analysis that found psychosis typically occurred 6.3 years after cannabis use began. There was insufficient data available at the time for age-group comparisons.

UNSW lead author Carly Stevens, from the School of Biomedical Sciences, said being able to compare life stages revealed a clearer picture of the link between cannabis and psychosis.

"What we've found challenges the assumption that you'll be fine if you wait to smoke weed until your mid-20s—that's just not the case," Stevens said.

"There's been so much emphasis on adolescents not smoking cannabis, which is important, but we need to broaden the warnings for everyone."

A couple of years can change a life

Delaying psychosis by a couple of years may not sound like much, but the shift can make a lifetime of difference, Stevens said. "People may miss out on study, job opportunities, travel and relationships in those years, and treatment can come with physical side effects that can make life harder as well."

Large said reducing or stopping cannabis use had clear benefits. "It's a major illness, which robs you of your shared reality with family, friends and all those around you," he said. "If we can delay psychosis by even a few years, people will be more likely to reach crucial milestones in education and training, and develop strong support networks, which can protect against psychosocial decline."

Delaying psychosis would further reduce the burden on the health care system, given that up to 3% of health-related expenditure in developed nations is attributed to psychotic disorders, he said.

Warnings need to expand

While the research does not prove causation, the researchers said the evidence supported the need for stronger public health warnings about the potential psychiatric consequences of cannabis use.

"We can't run direct experiments, so we have to go with the best evidence available," Large said. "In my view, the threshold for health warnings about cannabis and psychosis has definitely been met."

Complicating matters further is the rapid rise of medical cannabis, which Large said has led many people to underestimate the risks.

He noted a growing number of people he treated for psychosis had been prescribed cannabis for conditions where evidence of benefit was limited. "It's got this therapeutic halo around it, which blinds people to the risk."

Also of concern is the rise of cannabis edibles, which can have higher concentrations of tetrahydrocannabinol (THC), the primary psychoactive compound in cannabis.

While the legalization of cannabis would make access easier, it could help reduce harm by enabling governments to control potency, educate consumers and require informed purchasing. "You could tax it, regulate it, and require people to show they understand the risks before buying," Large said.

More research needed

The researchers say further investigation is needed into the potential biological mechanisms underlying cumulative cannabis exposure and psychosis onset. They also call for more work examining older cannabis users, who may face increasing risks as medical cannabis and high-potency products become more widely used.

Future studies also need clearer, standardized metrics for measuring cannabis exposure.

 

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Schizophrenia: Things you might not know about this mental disorder

Schizophrenia may not be as common as other mental disorders, but it is the most persistent and disabling of the major mental illnesses. Schizophrenia, if left untreated, can become chronic.

Schizophrenia is a severe mental disorder that affects how a person thinks, feels, and acts. It is not split personality or multiple personality.

Scientists are still unclear what causes schizophrenia. But there are some factors that contribute to the onset of schizophrenia. Perhaps, stressful experiences often precede the emergence of the disorder. Other risk factors include -

    Genetics (heredity)
    Chemical imbalance in the brain
    Environmental factors such as viral infections, immune disorders.

 Schizophrenia can affect anyone at any point in life, however, it most commonly strikes between the ages of 16 and 30, and males tend to show symptoms at a slightly younger age than females.

Symptoms can vary, depending on the individual and fall into four categories:

    Positive symptoms - Also known as psychotic symptoms, these include delusions (beliefs that are not true) and hallucinations ((hearing or seeing things that are not there).
    Negative symptoms – Social withdrawal, lack of motivation, etc.
    Cognitive symptoms – Trouble making decisions, using information, focusing or poor concentration.
    Emotional symptoms - These are usually negative symptoms, such as blunted emotions.

Unfortunately, there is as yet no cure for schizophrenia, but medication can help control many of the symptoms.

Therefore, medical treatment is the most important part of the program as proper treatment can help patients lead productive lives. Hence, the sooner the disorder is identified and treated for, the greater are the chances of recovery.

Today is World Schizophrenia Day. To raise awareness about schizophrenia and psychosis, as well as to reduce stigma around this complicated mental illness, World Schizophrenia Day is observed on May 24 each year.
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Living in cities 'puts teens at greater risk of psychotic experiences'

Teenagers who live in large cities could be at greater risk of having psychotic experiences, according to research examining the impact of urban life on mental health.

The finding ties in with previous studies and suggests that early interventions for young people in deprived urban neighbourhoods could be valuable.

“There is a growing interest in early interventions for psychosis and although it is important to highlight that the vast majority of these adolescents won’t go on to develop a psychotic disorder, early psychotic experiences are shown to be associated with a heightened risk for other mental health problems as well,” said Joanne Newbury, co-author of the research from King’s College London.

The research was published in Schizophrenia Bulletin by teams in the UK and US.

It drew on the Environmental Risk Longitudinal Twin Study, in which 2,063 18-year-olds in England and Wales were asked whether they had had any psychotic experiences since the age of 12, including delusions, hallucinations or concerns that their food had been poisoned. Just over 30% of the teens reported at least one psychotic experience over the period. 

Once factors including family psychiatric history, socioeconomic status and alcohol or cannabis dependence were taken into account, the odds were 43% higher for adolescents living in very urban settings – such as cities like London or Birmingham – than for rural teens.

Further analysis revealed the effect was at least in partly down to low levels of social cohesion, meaning poor relationships between neighbours, and high levels of neighbourhood disorder.

“We found that these factors explained around half of the association, or the effect of urbanicity on psychotic experiences,” said Newbury.

Being a victim of violence made the odds of an adolescent having psychotic experiences three times greater, while teens living in neighbourhoods with high disorder and low social cohesion were more likely to have been victimised.

The rate of psychotic experiences was three times higher among that group, at 62%, than among those who lived in more favourable neighbourhoods and had not been the victim of violent crimes, for whom the rate was 21%. 

However, the authors noted that the research does not prove that particular environmental settings are the cause of the higher rates of teen psychotic experiences. They pointed out that it was possible that those at greater risk of psychosis might move into urban environments.

But they said the study suggested that early interventions for the mental health of those living in urban neighbourhoods and deprived areas could prove valuable. 

James Kirkbride, a psychiatric epidemiologist from University College London, said: “We already know that people who are born, brought up in and live in cities have a higher chance of experiencing a psychotic disorder in their life. This new study shows that this extends to psychotic symptoms in adolescence as well.”

Kirkbride added that it was not yet clear what might be behind the link, although he noted that the latest study suggests that living in disadvantaged neighbourhoods or settings with high crime rates could be a factor. 

“Above all, this data shows that our most disadvantaged communities face a disproportionate burden of psychosis-related health inequalities in the UK, and require the provision of appropriate mental health services to tackle this issue,” he said. 

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Baby blues? Dear moms, postpartum depression is not your fault

What can possibly make a mother want to kill her baby? 
Postpartum depression, said the Mumbai High Court last week in a historic judgment that acquitted a 26-year-old new mother for attempting to kill her newborn twice, before abandoning him near a scrap heap. “She was incapable of realising the nature and consequences of her act… She did not know that it was wrong,” said the Mumbai High Court Bench while accepting her counsel’s insanity plea.

Postpartum disorders can take the form of blues, depression and psychosis, with the symptoms usually beginning the first few weeks after giving birth. A few may develop it later, sometimes even six months after birth, and are completely out of the mother’s control.
The mood changes happen because of the sudden drop in the female sex hormones estrogen and progesterone, and the thyroid hormones T3 (triiodothyronine) and T4 (thyroxine) immediately after birth. Add to that looking after a baby while juggling chores and you have mothers feeling lost and out of their depth.

Depression after childbirth, referred to as postpartum depression, is far more common in India than popularly believed. Worldwide, around one in 10 women get depressed immediately after giving birth, but the numbers of new mothers affected in India ranges between 15.3% and 23%, estimates the National Mental Health Survey 2015. Of them, around 16% – one in six new moms – continue to have symptoms six months after delivery.

The symptoms, which may last from a few days to a week, include mood swings, tiredness, sadness, crying irritability, feeling overwhelmed, anxiety, and changes in appetite and sleep patterns – women begin eating and sleeping too much or too little. If the symptoms last for more than a couple of weeks or are overwhelming enough to make them withdraw socially, affect their ability to care for themselves or the baby, or take their anger out on the baby, they need social and medical support.

The signs of postpartum psychosis – a very rare condition that usually develops within the first week after delivery – are even more severe and include paranoia, confusion and disorientation, hallucinations and delusions, and attempts to harm the self or the baby. Since it can quickly trigger dangerous thoughts and behaviour, treatment is a must.

What keeps most women from seeking help is often the embarrassment and shame they feel about not being good mothers. The pressure to be the perfect mother is immense, so many new moms hesitate to recognise or acknowledge that they are not, so it’s imperative for the family to closely look for signs of depression.

Depression in parents can also have a ripple effect, causing emotional strain for everyone close to a new baby. Parental depression, however mild, during the first years of parenting also raises the toddler’s chances of developing troubling behaviours, such as hitting, lying, anxiety and depression during the most critical time of a child’s development, reported a study in the journal, Couple and Family Psychology. Children of mothers with untreated postpartum depression also more likely to have sleeping and eating difficulties, excessive crying, ADHD (attention-deficit/hyperactivity disorder), and delays in language development.

The study shows new dads also get depressed after childbirth, with a man’s risk of depression after the birth of a child being greater than at any other time in his life. This study found that dad’s moods also influence his child’s behaviour during toddler years. In fact, parental depression affected a child’s mood and behaviour far more than parents fighting.

Children get affected because depression changes how people express emotions and interact with others. Depressed parents make less eye contact with their child and don’t smile as much as other parents. The more disengaged parents are in their child’s formative years, the more trouble the child will have in forming close attachments and developing social skills.

Apart from the obvious risk of recently giving birth, what raises risk are a personal or family history of depression or mood stability disorders, postpartum depression after a previous pregnancy, stressful events such as pregnancy complications, illness or job loss, if the baby has health problems or other special needs, marital or family conflict, poor family, social financial support, unplanned or unwanted pregnancy.

What mothers need to know is that if you’re not as happy as you are expected to be after having baby, it’s not your fault or the baby’s. It’s a biological change, much like high blood sugar, that can be easily treated with counseling and medicine.

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